Hello,

Laura's questions struck a cord with me as I am seeing more and more reasons 
to "supplement", according to the nurses (TIC!) I plain and simple do not 
have the "D" word in my vocabulary when working with mothers as it is so 
negative and undermines confidence in new moms.

I explain to moms that babies will have dry mouths if they are left to cry 
in the nursery or for that matter in moms rooms if she is showering, holding 
off feeds, etc. for any length of time, and that what is important is what 
the inside of the babies mouths are like not the "lips". I also reiterate 
that you cannot overfeed a baby when you are busy trying to get you body up 
to full milk production so see if the very next feed gets the baby more 
settled and happy.

The question if "urate crystals" are normal is an interesting one. I for one 
think that it is common, but do take it as a sign to evaluate milk transfer, 
fussiness, postmaturity, weight, etc. I do not panic when I see it, as I've 
seen this in babies at a little more than 24 hours of age, so I do not think 
it is always "dehydration". However if the baby is frantic, with dry mucous 
membranes and little audible swallowing, I might supp. with 1/2 ounce or so 
at the breast all the while encouraging mom to florce fluids in the early 
stages of lactation.

LuAnn Smith RN, IBCLC
York, PA

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